Priest John R, Hebert David, Jutras Camille
ECMO Program, Department of Respiratory Care, Lifespan Hospital System, Providence, RI, USA.
ECMO Program, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA.
Perfusion. 2025 Apr;40(3):547-556. doi: 10.1177/02676591241250288. Epub 2024 Apr 26.
Extracorporeal Membrane Oxygenation (ECMO) is a technology that offers organ support for critically ill patients with respiratory and/or cardiac failure. Despite improvements in recent years in technology and the biocompatibility of circuits, patients on ECMO remain at high risk of hematologic complications, such as bleeding or thrombosis. Anticoagulation is required in most cases to limit the risk of clotting, but questions persist regarding the optimal anticoagulation strategy. More precisely, there is still debate around the best anticoagulation agent and monitoring tools as well as on the transfusion thresholds and appropriate corrective measures when faced with complications. This narrative review provides an overview of hemostasis on ECMO and the impact of circuit size and coating. The benefits and downsides of unfractionated heparin (UHF) and Direct Thrombin Inhibitors (DTIs) as anticoagulation agents are reviewed. Finally, commonly available coagulation tests (activated clotting time, activated partial thrombin time, anti-Xa, and viscoelastic tests) and their limitations are addressed. In conclusion, future research is needed to determine the best anticoagulation strategy for patients on ECMO.
体外膜肺氧合（ECMO）是一种为患有呼吸和/或心力衰竭的重症患者提供器官支持的技术。尽管近年来技术及回路的生物相容性有所改善，但接受ECMO治疗的患者仍面临较高的血液学并发症风险，如出血或血栓形成。大多数情况下需要进行抗凝以降低凝血风险，但关于最佳抗凝策略仍存在问题。更确切地说，围绕最佳抗凝剂和监测工具，以及面对并发症时的输血阈值和适当纠正措施仍存在争议。本叙述性综述概述了ECMO上的止血情况以及回路大小和涂层的影响。综述了普通肝素（UHF）和直接凝血酶抑制剂（DTIs）作为抗凝剂的利弊。最后，讨论了常用的凝血试验（活化凝血时间、活化部分凝血活酶时间、抗Xa以及粘弹性试验）及其局限性。总之，需要进一步研究以确定ECMO患者的最佳抗凝策略。
